Usefulness of Routine Fractional Flow Reserve for Clinical Management of Coronary Artery Disease in Patients With Diabetes

Autor: Didier Barreau, Marco Costa, Michel Hanssen, Ruben Ramos, Patrick Dupouy, Eric Van Belle, Emmanuel Teiger, F Vincent, Eduardo Oliveira, Lino Santos, Alberto Rodrigues, Bruno da Silva, Christophe Pouillot, Pierre Barnay, Luís Nunes, Luís Raposo, Nuno Fonseca, Renato Fernandes, Maria-João Sousa, Elisabete Jorge, Luís Seca, J. Guardado, Cyril Besnard, Christophe Bretelle, John Henderson, João Costa, Alessandro Cosenza, Sina Porouchani, Rita Calé, Nicolas Lhoest, João Carlos Silva, Sérgio Bravo Baptista, Thomas Cuisset, Jean Dallongeville, Laurent Leborgne, Carina Machado, Loic Belle, Georgios Sideris
Přispěvatelé: Institut Coeur Poumon [CHU Lille], Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Département de Cardiologie [Hôpital de la Timone - APHM], Hôpital de la Timone [CHU - APHM] (TIMONE)-Assistance Publique - Hôpitaux de Marseille (APHM), Abbott (St. Jude Medical) Biotronik, Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE)
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Male
IMPACT
medicine.medical_treatment
[SDV]Life Sciences [q-bio]
Myocardial Infarction
Fractional flow reserve
Coronary Artery Disease
030204 cardiovascular system & hematology
Coronary Angiography
HSM CAR
ANGIOGRAPHY
Coronary artery disease
0302 clinical medicine
030212 general & internal medicine
Myocardial infarction
Prospective Studies
Coronary Artery Bypass
Original Investigation
education.field_of_study
RECLASSIFICATION
Diabetes
3. Good health
TIME
Fractional Flow Reserve
Myocardial
Cardiology
Female
REVASCULARIZATION
GUIDED PCI
Cardiology and Cardiovascular Medicine
medicine.medical_specialty
WAVE-FREE RATIO
Population
Clinical Decision-Making
Revascularization
STENOSIS
03 medical and health sciences
Percutaneous Coronary Intervention
[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system
Internal medicine
medicine
Diabetes Mellitus
Humans
STRATEGY
education
Aged
business.industry
Myocardial fractional flow reserve
Coronary Stenosis
Percutaneous coronary intervention
Cardiovascular Agents
medicine.disease
Cross-Sectional Studies
Cardiovascular agent
business
Mace
[SDV.MHEP]Life Sciences [q-bio]/Human health and pathology
Zdroj: JAMA Cardiology
JAMA Cardiology, American Medical Association 2020, 5 (3), pp.272. ⟨10.1001/jamacardio.2019.5097⟩
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Agência para a Sociedade do Conhecimento (UMIC)-FCT-Sociedade da Informação
instacron:RCAAP
JAMA Cardiology, 2020, 5 (3), pp.272. ⟨10.1001/jamacardio.2019.5097⟩
JAMA Cardiol
ISSN: 2380-6583
2380-6591
DOI: 10.1001/jamacardio.2019.5097⟩
Popis: International audience; This cross-sectional study evaluates the association of major adverse cardiac events (MACE) integrated with fractional flow reserve as the management strategy for diabetes with outcomes in patients with ambiguous lesions who undergo angiography.Key PointsQuestionWhat are the usefulness, rate of major adverse cardiovascular events (MACE), and clinical outcomes of routinely integrating fractional flow reserve in the management strategy for patients with diabetes who undergo coronary angiography? FindingsIn this cross-sectional study of 1983 patients, overall reclassification by fractional flow rate was high and similar in patients with diabetes (41.2%) and patients without diabetes (37.5%); however, reclassification from medical treatment to revascularization was more frequent among patients with diabetes. The rate of 1-year MACE was similar in reclassified (9.7%) and nonreclassified (12.0%) patients with diabetes, and the rate of MACE of patients deferred based on fractional flow reserve was similar among those with and without diabetes. MeaningThe findings suggest that management strategies guided by fractional flow reserve, including revascularization deferral, may be useful for patients with diabetes.ImportanceApproximately one-third of patients considered for coronary revascularization have diabetes, which is a major determinant of clinical outcomes, often influencing the choice of the revascularization strategy. The usefulness of fractional flow reserve (FFR) to guide treatment in this population is understudied and has been questioned. ObjectiveTo evaluate the usefulness and rate of major adverse cardiovascular events (MACE) of integrating FFR in management decisions for patients with diabetes who undergo coronary angiography. Design, Setting, and ParticipantsThis cross-sectional study used data from the PRIME-FFR study derived from the merger of the POST-IT study (Portuguese Study on the Evaluation of FFR-Guided Treatment of Coronary Disease [March 2012-November 2013]) and R3F study (French Study of FFR Integrated Multicenter Registries Implementation of FFR in Routine Practice [October 2008-June 2010]), 2 prospective multicenter registries that shared a common design. A population of all-comers for whom angiography disclosed ambiguous lesions was analyzed for rates, patterns, and outcomes associated with management reclassification, including revascularization deferral, in patients with vs without diabetes. Data analysis was performed from June to August 2018. Main Outcomes and MeasuresDeath from any cause, myocardial infarction, or unplanned revascularization (MACE) at 1 year. ResultsAmong 1983 patients (1503 [77%] male; mean [SD] age, 65 [10] years), 701 had diabetes, and FFR was performed for 1.4 lesions per patient (58.2% of lesions in the left anterior descending artery; mean [SD] stenosis, 56% [11%]; mean [SD] FFR, 0.81 [0.01]). Reclassification by FFR was high and similar in patients with and without diabetes (41.2% vs 37.5%, P=.13), but reclassification from medical treatment to revascularization was more frequent in the former (142 of 342 [41.5%] vs 230 of 730 [31.5%], P=.001). There was no statistical difference between the 1-year rates of MACE in reclassified (9.7%) and nonreclassified patients (12.0%) (P=.37). Among patients with diabetes, FFR-based deferral identified patients with a lower risk of MACE at 12 months (25 of 296 [8.4%]) compared with those undergoing revascularization (47 of 257 [13.1%]) (P=.04), and the rate was of the same magnitude of the observed rate among deferred patients without diabetes (7.9%, P=.87). Status of insulin treatment had no association with outcomes. Patients (6.6% of the population) in whom FFR was disregarded had the highest MACE rates regardless of diabetes status. Conclusions and RelevanceRoutine integration of FFR for the management of coronary artery disease in patients with diabetes may be associated with a high rate of treatment reclassification. Management strategies guided by FFR, including revascularization deferral, may be useful for patients with diabetes.
Databáze: OpenAIRE
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